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Because of the lockdowns and restrictions placed on non‐emergency medical services due to the COVID‐19 pandemic, we were prompted to set up telegenetic services for patients and families with genetic disorders. Genetic medicine poses special challenges because the unit of consultation and counseling is often the family and not just the individual. We describe here our experience over eight months in 2020 in evaluating 539 families with genetic disorders on a virtual platform. Patients from urban and rural districts of Karnataka and neighboring states received telegenetic consultation. Families were phoned by genetic counselors 14–28 days after the initial consultation to measure feedback. One member of each family was invited to complete a modified 9‐item Telehealth Satisfaction Scale (TeSS scale). Of 293 respondents, approximately 87.3% reported satisfaction with the visual and audio quality of online contact and 86.7% on saving travel time and expenses. A shorter waiting time for appointments as compared to in‐person appointments in the previous year was seen in approximately 90%. Nearly 87% reported satisfaction with online genetic consultation; however, 74% of these indicated a preference for a face‐to‐face appointment. The reasons for this included a cultural perception of confidence instilled by meeting medical specialists in person. Telegenetics presents unusual advantages in India because of the high usage of smartphones, unlimited Internet data as a feature of most Internet plans, free web‐based video applications, and digital payments. We suggest that telegenetics may be an alternative in providing a hybrid model of care in non‐emergency situations especially where resources are limited.

Background Long-term virologic data of children receiving antiretroviral therapy (ART) in India are limited. We examined the long-term virologic outcome of a pediatric cohort on non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based ART in south India. Methods Perinatally HIV infected children, between 2–12 years of age initiating NNRTI-based ART during 2010–2014 and with at least 12 months of follow-up, were included in analysis. CD4 cell counts and viral load measurements were performed at 24 and 48 weeks. Immunologic Failure (IF) was defined as decrease in CD4 count of > 30% from baseline; immunologic recovery (IR) as an increase in CD4 count of >25% from baseline while Virologic Failure (VF) was defined as HIV-RNA of >1,000 copies/ml at 48 weeks after ART initiation. Genotypic resistance testing was performed for children with VF. Logistic regression analysis was used to determine predictors of VF Results A total of 378 ART-naïve HIV infected children with mean age: 7.6 + 3 years, mean CD4%: 16% (8) and median HIV-RNA: 5.1 (3.5 – 5.7) log10 copies/ml, were enrolled. 74 % were started on nevirapine and 24% on efavirenz-based ART. At 48 weeks, 331 of 378 (88%) children completed follow-up, 15 died, 3 transferred out and 29 were lost to follow up. Significant improvement occurred in weight-for-age and height-for-age z-scores from baseline (all P < 0.001). 79% of children showed IR. VF was seen in 29% (94 / 328), while IF was seen in only 3% (10 / 331) of children. 62% of children with VF reported >90% adherence to ART. Of the 94 children with VF, 5 children showed IF. Correlation between VF and IF was absent. Sensitivity (95% CI) of IF to VF was 6% (2.2–14.6), specificity 98% (94.9–99.5), PPV 56% (26.7–81.1) and NPV was 73.4% (67.8–78.4). At the time of VF, multiple NNRTI-associated mutations were observed in 80% (52/65) of children - K103N and Y181C were the major NNRTI DRMs onserved. M184V also was observed in 79% of children with VF. No definite predictors of VF could be determined. Conclusion Though ART provides significant benefit to children in India, over a quarter of them had VF and developed major drug-resistance mutations after 48 weeks of ART. There is a lack of correlation between IF and VF, leading to delay in identifying treatment failure. Periodic plasma HIV-RNA testing should be performed to detect treatment failures early. Disclosures All authors: No reported disclosures.